DR. JOHN C. DERICKSON (NPI# 1972505477) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1972505477 |
| Entity Type | Individual |
| Full Name | DR. JOHN C. DERICKSON |
| Credential | O.D. |
| Practice Address |
8771 Perimeter Park Ct Suite 101 Jacksonville FL 32216-6396 |
| Practice Telephone | 9049978585 |
| Practice Fax Number | 9049980054 |
| Mailing Telephone | 9049978585 |
| Mailing Fax Number | 9049980054 |
| Enumeration Date | 2005-08-15 |
| Last Update Date | 2008-12-12 |
| NPI Deactivation Date | 03/22/2006 |
| NPI Reactivation Date | 2006-04-10 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 152W00000X | Optometrist | OPC3107 | FL | Eye and Vision Services Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| FL | BLUE CROSS BLUE SHIELD | 20964 | 01 |
| FL | PGBA, LLC TRICARE SOUTH REGION | 593473512 | 01 |
| Street Address |
8771 PERIMETER PARK CT SUITE 101 |
| City | JACKSONVILLE |
| State | FL |
| Zip Code | 32216-6396 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1245616317 | Matthew Sutton | Optometrist | 8771 Perimeter Park Ct, Suite 101, Jacksonville, FL 32216-6396 | 2015-07-30 |
| 1356686976 | John C. Derickson Od, Pa | Optometrist | 8771 Perimeter Park Ct, Suite 101, Jacksonville, FL 32216-6396 | 2012-12-07 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1013524925 | Renee Cherie Titus | Behavior Technician | Growing Together Center 6789 Southpoint Parkway, Building 100, Jacksonville, FL 32216 | 2020-09-24 |
| 1811546575 | First Coast Orthopedic Center, LLC | Clinic/Center | 4035 Southpoint Boulevard, Jacksonville, FL 32216 | 2019-09-05 |
| 1922578558 | Fatima Hussain Crofton | Optometrist | 7051 Southpoint Parkway S 300, Jacksonville, FL 32216 | 2018-11-27 |
| 1154802833 | John-paul Pham | Internal Medicine | 4141 Southpoint Drive East, Suite D, Jacksonville, FL 32216 | 2018-08-22 |
| 1790279479 | Joseph Richard Kennedy | Physician Assistant | 6650 Corporate Center Pkwy Apt 1604, Jacksonville, FL 32216 | 2018-06-18 |
| 1801304357 | Kelli M. Tyson | Nurse Practitioner | 3550 University Blvd. S., Ste 302, Jacksonville, FL 32216 | 2018-01-18 |
| 1376054809 | Angela M Whittinghill | Counselor | 8833 Perimeter Park Blvd #702, Jacksonville, FL 32216 | 2017-10-24 |
| 1629508072 | Zoryana Yufan | Dentist | 8750 Perimeter Park Blvd Ste 101, Jacksonville, FL 32216 | 2017-06-19 |
| 1700318896 | Christina Kaczmarek | Behavior Technician | 6816 Southpoint Pkwy Ste 500, Jacksonville, FL 32216 | 2017-03-29 |
| 1932640422 | Loudine Racius | Nurse Practitioner | 8539 Gate Parkway W, Unit 1422, Jacksonville, FL 32216 | 2017-03-16 |
| Find all providers in zip 32216 | ||||
| Taxonomy Code | 152W00000X |
| Grouping | Eye and Vision Services Providers |
| Classification | Optometrist |
| Doctors of optometry (ODs) are the primary health care professionals for the eye. Optometrists examine, diagnose, treat, and manage diseases, injuries, and disorders of the visual system, the eye, and associated structures as well as identify related systemic conditions affecting the eye. An optometrist has completed pre-professional undergraduate education in a college or university and four years of professional education at a college of optometry, leading to the doctor of optometry (O.D.) degree. Some optometrists complete an optional residency in a specific area of practice. Optometrists are eye health care professionals state-licensed to diagnose and treat diseases and disorders of the eye and visual system. |
| Notes: Source: American Optometric Association (AOA), approved by the AOA’s Board of Trustees, June 21, 2005. [7/1/2006: definition modified] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1215553367 | Myeyedr Optometry of Florida, LLC | Optometrist | 2152 3rd St S # 60, Jacksonville, FL 32250-4019 | 2020-06-24 |
| 1154945814 | Kaitlin Jaquett Brown | Optometrist | 4788 Hodges Blvd Ste 205, Jacksonville, FL 32224-7223 | 2020-05-29 |
| 1831745660 | National Vision Inc | Optometrist | 14021 Lunar Drive, Unit 1, Jacksonville, FL 32218-7290 | 2019-08-16 |
| 1144876475 | Myeyedr Optometry of Florida, LLC | Optometrist | 11945 San Jose Blvd Ste 202, Jacksonville, FL 32223-1612 | 2019-08-13 |
| 1295294742 | Myeyedr Optometry of Florida, LLC | Optometrist | 13760 Old Saint Augustine Rd Ste 102, Jacksonville, FL 32258-5492 | 2019-03-14 |
| 1922578558 | Fatima Hussain Crofton | Optometrist | 7051 Southpoint Parkway S 300, Jacksonville, FL 32216 | 2018-11-27 |
| 1356820211 | Nisha Patel | Optometrist | 10300 Southside Blvd Ste 114, Jacksonville, FL 32256-6759 | 2018-08-11 |
| 1538650155 | Vision Today Pllc | Optometrist | 9365-2 Atlantic Blvd, Jacksonville, FL 32225-8203 | 2018-05-21 |
| 1447765748 | Sudduth Vision Pllc | Optometrist | 8000 Parramore Rd., Jacksonville, FL 32244 | 2017-12-08 |
| 1851806657 | Ann Huynh Nguyen | Optometrist | 9041 Southside Blvd Ste 174, Jacksonville, FL 32256-8482 | 2017-12-04 |
| Find all providers in JACKSONVILLE | ||||
| City | JACKSONVILLE |
| Zip Code | 32216 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.